Delayed healing or post-operative recurrence in pediatric spinal tuberculosis: efficacy of individualized re-operation

doi:10.3969/j.issn.2095-4344.2015.17.015

Abstract

Abstract:

BACKGROUND: Due to the emergence of drug-resistant tuberculosis and mismanagement in tuberculosis patients, the incidence of delayed healing or recurrent after spinal tuberculosis surgery is gradually increasing, especially in strongly predisposal children. Therefore, exploring the risk factors of delayed healing or post-operative recurrence in pediatric patients after spinal tuberculosis surgery, will have significance in the prevention and treatment of tuberculosis.

OBJECTIVE: To analyze the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis, and evaluate the efficacy of individualized re-operation.

METHODS: From June 1998 to June 2013, clinical data of 145 pediatric patients with spinal tuberculosis were reviewed retrospectively, and some cases of delayed healing or post-operative recurrence in spinal tuberculosis were compared with other without delayed healing or post-operative recurrence. The patient’s age, gender, nutritional condition, lesion debridement, history of chemotherapy and internal fixation, complicated spinal lesion, scope of lesions, preoperative erythrocyte sedimentation rate > 60 mm/h, and postoperative complications were analyzed by Logistic regression analysis. The risk factors of delayed healing or post-operative recurrence were analyzed. After re-operation, erythrocyte sedimentation rate, C-reactive protein and imaging studies were detected.

RESULTS AND CONCLUSION: After surgery, 29 cases appeared delayed healing or post-operative recurrence and 12 of them received re-operation. The incidence of delayed healing or post-operative recurrence in pediatric spinal tuberculosis was 20% and the re-operation rate was 8.3%. Logistic regression analysis showed that, nutritional condition, history of chemotherapy, lesion debridement, and scope of lesions were significantly correlated with delayed healing or post-operative recurrence (P < 0.05). While patient’s age, gender, history of internal fixation, complicated spinal lesion, preoperative erythrocyte sedimentation rate > 60 mm/h, and postoperative complications had no correlation with the delayed healing or post-operative recurrence (P > 0.05). Individualized re-operation can achieve good outcomes. Experimental findings indicate that, the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis are very complex, enhancing the nutrition, complete debridement of lesions, and receiving chemotherapy can effectively decrease the incidence. According to the initial surgery and patient’s conditions, individualized re-operation is the key to the success.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Tuberculosis, Spinal, Recurrence, Risk Factors

CLC Number:

R318

Zhang Xiao-dong, Mardan•Mamat, Yakup•Abulizi, Ailixier, Sheng Wei-bin, Deng Qiang . Delayed healing or post-operative recurrence in pediatric spinal tuberculosis: efficacy of individualized re-operation[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(17): 2704-2710.

Figures/Tables 2

多因素Logistic回归分析：自身营养情况、修复前后正规化疗、病灶范围广泛、病灶清除是否彻底4个因素与小儿脊柱结核术后结核迁延不愈或复发有显著相关性(P < 0.05，表6)。 2.3 再次修复效果所有患儿均顺利完成手术，术中未出现大血管、神经、脊髓的损害。手术时间80-185 min，平均105.8 min；术中出血量80-1 200 mL，平均305.8 mL；术中扩大手术切口，充分暴露病灶区域，术中彻底清除窦道、脓液、死骨、坏死组织。术中有2例患儿胸膜破损，当即予以缝合并留置胸腔闭式引流管，术后待引流量低于50 mL后拔出引流管。1例患儿术后引流量较多，为清亮液体，考虑脑脊液漏，予以去枕平卧、局部加压，并放置蛛网膜下腔引流管，待引流管内液体小于20 mL时拔出，3 d后拔除蛛网膜下腔引流管。1例患儿术后出现低蛋白血症合并切口延迟愈合，予以多次少量红细胞悬液滴注、输注人血白蛋白治疗，切口逐渐愈合低蛋白血症逐渐纠正。 2.4 疗效评价所有再次手术患儿均获得随访，随访时间12-60个月。所有患儿术后严格正规抗结核治疗，血沉、C-反应蛋白在术后9-18个月逐渐恢复正常；随访期间6个月后均无植骨块吸收、移位及窦道形成等结核复发迹象。病灶区植骨块在术后9-12个月达到骨性愈合。 2.5 典型病例女性患儿，6岁，胸腰椎多节段结核，初次全麻下行前路病灶清除、异体骨植入融合内固定，术后抗结核药物治疗。患儿治疗5个月后内固定移位，并且脓肿再次聚集，遂再次行修复治疗，行一期后路内固定矫形，前路病灶清除、内固定取出，术后病情恢复良好，见图1。 2.6 不良事件 12例再次修复的患儿中， 2例患儿术后出现胸腔积液，1例患儿术后出现脑脊液漏，1例患儿术后低蛋白血症并切口延迟愈合，未出现神经、脊髓损伤等并发症。"

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